P33

Sample Flexibility Plan for Beginners

Stretching the body’s muscles provides Safety freedom of movement to do the things • If you have had a hip or knee you need to do and the things you like replacement, check with your surgeon to do. Stretching can improve your before doing lower body exercises. flexibility, although it will not improve • Always warm up before doing your endurance or strength. stretching exercises. For example, do them after endurance or How Much, How Often strength exercises or, if you are • Stretch after you do your doing only stretching exercises on a regularly scheduled strength and particular day, do a little bit of easy aerobic activities. You should walking and arm-pumping first. be stretching every day. • Stretching should never cause pain, • If you can’t do endurance or strength especially joint pain. If it does, you exercises, and stretching exercises are stretching too far and you need to are the only kind you are able to do, reduce the stretch so that it doesn’t do them at least 3 times a week, for hurt. Mild discomfort or a mild at least 20 minutes each session. pulling sensation is normal. Never • Do each stretching exercise at least “bounce” into a stretch; make slow, 4 times each session. Slowly stretch steady movements instead. Jerking into the desired position, as far as into position can cause muscles to possible without pain, and hold the tighten, possibly resulting in injury. stretch for 15–60 seconds. Relax, then • Avoid “locking” your joints into repeat, trying to stretch a little farther. place when you straighten them Always remember to breathe while during stretches. Your arms and stretching. Counting out loud can legs should be straight when you help ensure that you are breathing. stretch them, but you should always have a very small amount of bend in your joints while stretching.

www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 1 of 7 • Some of the exercises require you to the way to know how to limit yourself lie on the floor. If you are afraid to lie is that stretching should never hurt. It on the floor because you think you may feel slightly uncomfortable, but not won’t be able to get back up, consider painful. Push yourself to stretch farther, exercising with a buddy, in a chair, or but not so far that it hurts. Perform in the pool. Alternatively, keep a chair the following exercises, in order, as nearby to use as support in getting described below. up. All stretches can be modified. Detailed instructions for each exercise Getting Started are provided at the end of this handout Stretching exercises are generally and are taken from Exercise: A Guide performed at a low intensity. You can from the National Institute on Aging. progress in your stretching exercises;

STRETCH REPETITIONS, SETS, AND SESSIONS

Flexibility Exercise/ # of repetitions # of sets # of sessions Stretch per set per session per week Hamstrings 4 per side 1 After every aerobic or strength session

Alternative Hamstrings 4 per side 1 After every aerobic or strength session

Calves 4 per side 1 After every aerobic or strength session

Ankles 4 per side 1 After every aerobic or strength session

Triceps 4 per side 1 After every aerobic or strength session

Wrists 4 per side 1 After every aerobic or strength session

Quadriceps 4 per side 1 After every aerobic or strength session

Double Hip Rotation 4 per side 1 After every aerobic or strength session

Single Hip Rotation 4 per side 1 After every aerobic or strength session

Shoulder Rotation 4 per side 1 After every aerobic or strength session

Neck Rotation 4 per side 1 After every aerobic or strength session

Side Leg Raise 4 per side 1 After every aerobic or strength session

If you are not currently doing aerobic or strength activities, do flexibility and stretching at least 3 times per week for at least 20 minutes per session.

www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 2 of 7 EXERCISES

Hamstrings Stretches muscles in the back of the thigh • Sit sideways on bench or other hard surface (such as two chairs placed side by side). • Keep one leg stretched out on bench, straight, toes pointing up. • Keep other leg off of bench, with foot flat on floor. • Straighten back. • If you feel a stretch at this point, hold the position for 15–60 seconds. • If you don’t feel a stretch, lean forward from hips (not waist) until you feel stretching in leg on bench, keeping back and shoulders straight. Omit this step if you have had a hip replacement, unless surgeon/therapist approves. • Hold position for 15–60 seconds. • Repeat with other leg. • Repeat at least 4 times on each side.

Alternative Hamstrings Stretch Stretches muscles in the back of the thigh • Stand behind chair, holding on with both hands. • Bend forward from the hips (not waist), keeping back and shoulders straight at all times. • When upper body is parallel to floor, hold position for 15–60 seconds. You should feel a stretch in the backs of your thighs. • Repeat at least 4 times.

Calves Stretches lower leg muscles in two ways: with knee straight and knee bent • Stand with hands against wall, arms outstretched and elbows straight. • Keeping your left knee slightly bent, toes of right foot slightly turned inward, step back 1–2 feet with right leg, heel, and foot flat on floor. You should feel a stretch in your calf muscle, but you shouldn’t feel uncomfortable. If you don’t feel a stretch, move your foot farther back until you do. www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 3 of 7 • Hold position for 15–60 seconds. • Bend knee of right leg, keep heel and foot flat on floor. • Hold position for another 15–60 seconds. • Repeat with left leg. • Repeat at least 4 times for each leg.

Ankles Stretches front ankle muscles • Remove your shoes. Sit toward the front edge of a chair and lean back, using pillows to support your back. • Stretch legs out in front of you. • With your heels still on the floor, bend ankles to point feet toward you. • Next, bend ankles to point feet away from you. • If you don’t feel the stretch, repeat with your feet slightly off the floor. • Hold the position for 15–60 seconds. • Repeat at least 4 times.

Triceps Stretches muscles in back of upper arm • Hold one end of a towel in right hand. • Raise and bend right arm to drape towel down back. Keep your right arm in this position, and continue holding onto the towel. • Reach behind your lower back and grasp bottom end of towel with left hand. • Climb left hand progressively higher up towel, which also pulls your right arm down. Continue until your hands touch, or as close to that as you can comfortably go. Hold for 15–60 seconds. • Reverse positions. • Repeat each position at least 4 times.

www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 4 of 7 Wrists Stretches wrist muscles • Place hands together, in praying position. • Slowly raise elbows so arms are parallel to floor, keeping hands flat against each other. • Hold position for 15–60 seconds. • Repeat at least 4 times.

FLOOR EXERCISES

About Floor Exercises

Most of the remaining exercises are Knowing the right way to get into a done on the floor and stretch some lying position on the floor and to get very important muscle groups. If you back up also may be helpful. If you are afraid to lie on the floor to exercise have had a hip replacement, check with because you think you won’t be able to your surgeon before using the following get back up, consider using the buddy methods. If you have osteoporosis, system to do these. Find a buddy who check with your doctor first. will be able to help you.

To get into a lying position: To get up from a lying position: • Stand next to a very sturdy chair that won’t tip • Roll onto your left side. over (put chair against wall for support if you • Use your right hand, placed on the floor at need to). about the level of your ribs, to push your • Put your hands on the seat of the chair. shoulders off the floor. • Lower yourself down on one knee. • Your weight is on your left hip. • Bring the other knee down. • Roll forward, onto your knees, leaning on your • Put your left hand on the floor and lean on it hands for support. Lean your hands on the as you bring your left hip to the floor. seat of the chair you used to lie down. • Your weight is now on your left hip. • Lift one of your knees so that one leg is bent, foot flat on the floor. • Straighten your legs out. • Leaning your hands on the seat of the chair for • Lie on your left side. support, rise from this position. • Roll onto your back. Note: You don’t have to use your left side. Note: You don’t have to use your left side. You can reverse positions, if you prefer. You can use your right side, if you prefer.

www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 5 of 7 Quadriceps Stretches muscles in front of thighs • Lie on side on the floor. Your hips should be lined up so that one is directly above the other one. • Rest head on pillow or hand. • Bend knee that is on top. • Reach back and grab heel of that leg. If you can’t reach your heel with your hand, loop a belt over your foot and hold belt ends. • Gently pull that leg until front of thigh stretches. • Hold position for 15–60 seconds. • Reverse position and repeat. • Repeat at least 4 times on each side. If the back of your thigh cramps during this exercise, stretch your leg and try again, more slowly.

Shoulder Rotation Stretches shoulder muscles • Lie flat on floor, pillow under head, legs straight. If your back bothers you, place a rolled towel under your knees. • Stretch arms straight out to side. Your shoulders and upper arms will remain flat on the floor throughout this exercise. • Bend elbows so that your hands are pointing toward the ceiling. • Let your arms slowly roll backwards from the elbow. Stop when you feel a stretch or slight discomfort, and stop immediately if you feel a pinching sensation or a sharp pain. • Hold position for 15–60 seconds. • Slowly raise your arms, still bent at the elbow, to point toward the ceiling again. Then let your arms slowly roll forward, remaining bent at the elbow, to point toward your hips. Stop when you feel a stretch or slight discomfort. • Hold position for 15–60 seconds. • Alternate pointing above head, then toward ceiling, then toward hips. Begin and end with pointing-above-head position. • Repeat 4 times.

www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 6 of 7 Double Hip Rotation Stretches outer muscles of hips and thighs. Unless your surgeon approves, don’t do this exercise if you have had a hip replacement • Lie on floor on your back, knees bent and feet flat on the floor. • Keep shoulders on floor at all times. • Keeping knees bent and together, gently lower legs to one side as far as possible without forcing them. • Hold position for 15–60 seconds. • Return legs to upright position. • Repeat toward other side. • Repeat at least 4 times on each side.

Single Hip Rotation Stretches muscles of pelvis and inner thigh. Unless your surgeon approves, don’t do this exercise if you have had a hip replacement • Lie on your back on floor, knees bent and feet flat on the floor. • Keep shoulders on floor throughout exercise. • Lower one knee slowly to side, keeping the other leg and your pelvis in place. • Hold position for 15–60 seconds. • Bring knee back up slowly. • Repeat with other knee. • Repeat at least 4 times on each side.

Neck Rotation Stretches neck muscles • Lie on the floor with a phone book or other thick book under your head. • Slowly turn head from side-to-side, holding position each time for 15–60 seconds on each side. Your head should not be tipped forward or backward, but should be in a comfortable position. You can keep your knees bent to keep your back comfortable during this exercise. • Repeat at least 4 times.

www.move.va.gov Physical Activity Handouts • P33 Version 5.0 Page 7 of 7